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Author
Topic: UAB to begin routine HIV screening (Read 12116 times)

Beginning in mid-July, UAB (University of Alabama at Birmingham) Hospital will start screening all ER patients (unless they sign a form to opt-out) for HIV. If they come in unconscious or unable to communicate, they will be tested.

Our clinic, the 1917 AIDS Clinic at UAB, is preparing for the increase to our patient load. Overall, I think it's a good idea to do routine testing, but I know the funding is not there to treat those who test positive. Our patient load has already surpassed 2,000.

Once again, more people are to receive care from the SAME, limited funding sources.

Scary times.....

Logged

"Remember my sentimental friend that a heart is not judged by how much you love, but by how much you are loved by others." - The Wizard of Oz

The principle underpinning HIV screening in most parts of the world has placed great emphasis on patient consent. Receiving an HIV diagnosis is a life changing experience, people should have the right to decide if that's where they're at etc . . .

Especially if folks live in a place where being HIV positive still carries a greater than average stigma it can deter them from seeking medical assistance.

I'm not saying that the stigma is greater in 'Bama either. I suspect it might be, but I can't be sure.

Opt out processes also work against people who may have problems navigating health services; the poor, the mentally fucked etc. Opt out processes can be abused by some health care workers.

And as Alan notes if the authorities have not increased resources to cope with the increase in the number of known positive people there will be big problems.

I am unsure how I feel about this myself . I am a patient at UAB so I did a little research to see why they plan on doing this . After reading about the plan and discovering the primary reason for this is to help curb new infections by identifying people who are not aware they are positive I really don't think its really such a good idea after all . The program is going to run for 3 years leaving me to wonder if this is a study to see if mandatory testing should be done nation wide .

If HIV testing was mandatory nation wide and treatment was available on demand I may could see how it could be an effective tool to curb transmissions . I'm not saying I support mandatory testing either but one hospital in one city spending milloins of dollars for HIV testing just doesn't seem like an effective way to go ... I am uneasy about this so far .

Could you elaborate. I mean if I am unconscious or unable to communicate, how dare you, if without prior consent, living will etc. do this without permission? This is so wrong in so many ways. I want to state that I think everyone should test and clearly test frequently as these days no one is to be trusted, but to test someone without permission, I don't think so, particularly in this country where you have to fight tooth and nail to get a procedure to just frigging live.

With as many as 25 percent of people with HIV being unaware of their infection and data stating that those on treatment are 96 percent less likely to transmit the virus, infering that the majority of transmission are from those untreated, I agree its a good idea as well.

Not only that, but untreated HIV is dangerous. I am all for people knowing their status. Waiting for someone to decide to test can be too late, for themselves and for those they end up infecting in the mean time. As a matter of public health it seems to be the responsible option.

With as many as 25 percent of people with HIV being unaware of their infection and data stating that those on treatment are 96 percent less likely to transmit the virus, infering that the majority of transmission are from those untreated, I agree its a good idea as well.

Not only that, but untreated HIV is dangerous. I am all for people knowing their status. Waiting for someone to decide to test can be too late, for themselves and for those they end up infecting in the mean time. As a matter of public health it seems to be the responsible option.

Jesus Titty Fucking Christ. Always with the infecting.

People infect themselves. How many times does this have to be pointed out? If you insist on condoms for anal and/or vaginal sex it doesn't matter if your partner is HIV positive or not.

The inability of so many to take responsibility for themselves is not a reason to undermine fundamental principles of healthcare delivery like informed consent.

With as many as 25 percent of people with HIV being unaware of their infection and data stating that those on treatment are 96 percent less likely to transmit the virus, infering that the majority of transmission are from those untreated, I agree its a good idea as well.

Not only that, but untreated HIV is dangerous. I am all for people knowing their status. Waiting for someone to decide to test can be too late, for themselves and for those they end up infecting in the mean time. As a matter of public health it seems to be the responsible option.

The responsible option is for people to wear condoms -If it is a matter of public health - let's just quarantine everyone with HIV. Hey, while were at it, we should give mandatory vasectomies or "tie the tubes" of anyone who is unwed who has a child. Hey, we could drug test all citizens and shoot the ones who test positive for drugs. Hey, we should also shoot everyone who smokes cigarettes (afterall secondhand smoke kills); shoot those who drink alcohol and neglect their children, cause crashes when under the influence; or don't cover their mouth when they sneeze; sell cholesterol raising fast food.....I'm sure I can think of other public health risks that could easily be solved by removing the responsibility from the person for addressing it and/or avoiding it and shifting the responsibility to the government. Sounds like a great plan

The responsible option is for people to wear condoms -If it is a matter of public health - let's just quarantine everyone with HIV. Hey, while were at it, we should give mandatory vasectomies or "tie the tubes" of anyone who is unwed who has a child. Hey, we could drug test all citizens and shoot the ones who test positive for drugs. Hey, we should also shoot everyone who smokes cigarettes (afterall secondhand smoke kills); shoot those who drink alcohol and neglect their children, cause crashes when under the influence; or don't cover their mouth when they sneeze; sell cholesterol raising fast food.....I'm sure I can think of other public health risks that could easily be solved by removing the responsibility from the person for addressing it and/or avoiding it and shifting the responsibility to the government. Sounds like a great plan

One of the problems with HIV is that so many people don't realize that they have it. Early detection of HIV is important so people can start treatment and studies are showing that starting on HIV therapy before your immune system is severely compromised is of benefit. Also, even if someone with HIV didn't change his or her sexual habits, having their viral load undetectable would help reduce transmission. Hopefully we can all agree that people knowing if they have HIV is important.

So then the issue becomes one of testing people in emergency departments for HIV. I work in an emergency department and the staff routinely tests patients for various conditions without asking for specific consent. They draw blood and urine and look at any number of conditions: pregnancy, drug use, alcohol intoxication, anemia, influenza, tuberculosis, viral infection, bacterial infection, diabetes, etc. Why should HIV, a virus, be different? What is so special about HIV? HIV can be life threatening. So are a lot of other conditions. HIV is communicable. So are a lot of other conditions. Is it because HIV has a stigma? So does syphilis, herpes, lice, mental illness, etc. but we still test for those. Some argue it is upsetting and life changing to discover you have HIV. Well, so does finding out you have cancer or a brain tumor or a host of other conditions.

What is so special about HIV? Nothing. HIV is like cancer, heart disease and a host of of other conditions that millions of people have, don't know they have and they are going to suffer for their ignorance. Stop perpetuating stigma by putting HIV in it's own special category. It is a virus, a matter of public health and everyone would be better of treating it as such.

If someone doesn't want to be tested they can opt out. If someone is so terrified of being tested for HIV then I suggest they contact their local emergency department and have a list put in their chart of all the bad things they just don't want to know about.

So, One point is not clear: How is the privacy policy about the results of these tests? do they call the patient away and tell the news, or do they announce it regardless who is in the room? and if they find the patient positive, do they inform family, or employers?

In my case, I want to control the choice if I want the test or not, and the people I will disclose my status if the results were positive.

Why dedicate so many resources to these tests instead of supporting the meds programs out there?

So then the issue becomes one of testing people in emergency departments for HIV. I work in an emergency department and the staff routinely tests patients for various conditions without asking for specific consent. They draw blood and urine and look at any number of conditions: pregnancy, drug use, alcohol intoxication, anemia, influenza, tuberculosis, viral infection, bacterial infection, diabetes, etc. Why should HIV, a virus, be different? What is so special about HIV? HIV can be life threatening. So are a lot of other conditions. HIV is communicable. So are a lot of other conditions. Is it because HIV has a stigma? So does syphilis, herpes, lice, mental illness, etc. but we still test for those. Some argue it is upsetting and life changing to discover you have HIV. Well, so does finding out you have cancer or a brain tumor or a host of other conditions.

What is so special about HIV? Nothing. HIV is like cancer, heart disease and a host of of other conditions that millions of people have, don't know they have and they are going to suffer for their ignorance. Stop perpetuating stigma by putting HIV in it's own special category. It is a virus, a matter of public health and everyone would be better of treating it as such.

What's so special about HIV? Well it's not an acute condition. I can't think of a pressing medical emergency where testing for HIV without the consent of the patient would be a triage priority.

What's so special about HIV? It's a deeply stigmatised condition and people should have the right to consider the ramifications of testing before it occurs. Not just the social ramifications but the legal consequences as well.

People should have the right to refuse an HIV test should the fancy seize them. Not be subjected to the tyranny of Accident and Emergency staff.

It's a slow progressing terminal illness which is extensively expensive to treat long term which is spread through sexual contact. Someone not knowing they are infected has the potential to spread the disease unknowingly to a lot of other people. Not to mention the effects carrying the disease and being unaware of it can cause to your own health.

I am of the opinion people should be tested along with driver's license and voter registration and informed of their positive or negative status. I really don't see what potentially dangerous side effect comes as a result from knowing your hiv status.

Why should HIV, a virus, be different? What is so special about HIV? HIV can be life threatening. So are a lot of other conditions. HIV is communicable. So are a lot of other conditions. Is it because HIV has a stigma? So does syphilis, herpes, lice, mental illness, etc. but we still test for those. Some argue it is upsetting and life changing to discover you have HIV. Well, so does finding out you have cancer or a brain tumor or a host of other conditions.

What is so special about HIV? Nothing. HIV is like cancer, heart disease and a host of of other conditions that millions of people have, don't know they have and they are going to suffer for their ignorance. Stop perpetuating stigma by putting HIV in it's own special category. It is a virus, a matter of public health and everyone would be better of treating it as such.

If someone doesn't want to be tested they can opt out. If someone is so terrified of being tested for HIV then I suggest they contact their local emergency department and have a list put in their chart of all the bad things they just don't want to know about.

HIV is a virus, yes. However, there is an immense amount of prejudice, phobia, misinformation which fuels the *stigma* attached to HIV which, in my opinion, makes it *incomparable* to any other medical condition.

Telling someone that they are HIV positive, without their consent can precipitate an excruciating emotional trauma in people and their family members. It can and has led to sudden suicides and other hasty/drastic acts. Receiving an HIV diagnosis is *not* the same thing as getting a diagnosis of cancer or MS. An HIV diagnosis, by most people, would be processed very differently at an emotional level. A lot of people blame themselves for letting their guard down and allowing this to happen to them. In addition to that, people fear disclosing their status out of fear of discrimination in the work place or elsewhere. Many many people still think of a positive person as someone who is irresponsible and/or promiscuous.

Having said that, WE do know that all of these fears/prejudices that fuel the stigma against us are completely flawed and MUST be reduced. BUT HIV TESTING without someoneís consent, in my opinion, is likely to make it harder for people receiving unexpected life changing information and for those around them. It will only feed the viscious cycle of stigma and fear in peopleís psyche that we need to test people ďcos OMG! There are so many poz people going around spreading the virus without knowing it..lets stop this madness!Ē. Testing without consent, at the end of the day is just so wrong at so many levels because however you dress it up it is a blatant infringement of one's privacy.

I wish there werenít so many bigoted, homophobic, HIV phobic people in the world. But you know what, they are still here and they are here to stay, so instead of endorsing policies that only add to the stigma against poz people other more viable solutions need to be examined such as encouraging Voluntary testing and campaigns of similar nature.

To me this is the equivalent of saying that testing for cancer is an infringement on your privacy. If it found your cancer early enough and saved your life would you still be against it?

Yes, I do think that diagnosing someone with breast cancer without their consent is vastly different to diagnosing someone with HIV without their consent.

I do realise the importance of early detection of HIV and truly appreciate the urgency to stem new infections which are a direct consequence of undiagnosed infections. However, I firmly believe that a personís right to privacy about their health status, particularly HIV, is more important for the reasons stated in my previous post.

There are exceptions of course, and I am not suggesting that doctors deliberately hide the fact that someone has HIV to the patientís detriment. But testing of people *without their consent* is wrong. Period. At the very least there should be some sort of consent of the *most affected party*.

The majority of poz people have acquired their infection as a direct consequence of certain risks they have taken. *The onus of their health only lies on them*. Thatís just the way I feel.

Compulsory testing *without consent*, in my mind is as flagrant a violation of a personís privacy as disclosure of someoneís HIV status without their consent. Supporting such a policy can snowball into much worse violations of privacy and rights of people.

What do you think they will propose next? That every poz person have a scorpion tattooed on their genitals so that the vast majority of people can protect themselves from being infected from the disease spreading monsters?

PS- Sorry, I was a bit over the top with my imagination in the last para lol. But I think you get my drift.

Spacebarsux, your issue appears not with testing in an emergency department but with testing without consent. In the scenario that Alan described people had the chance to opt out of being tested. If it was policy that unconscious patients would not be tested would you still have an objection?

Spacebarsux, your issue appears not with testing in an emergency department but with testing without consent. In the scenario that Alan described people had the chance to opt out of being tested. If it was policy that unconscious patients would not be tested would you still have an objection?

Technically, it is still testing without consent, is it not? Obviously, if someone is unconscious they cannot consent, but if an HIV test means saving their life in order to give them proper treatment then yes, a test would be required. I am not a doctor though, but I donít think an HIV test would help in assisting the patient who is ill and subconscious in ER, or would it? If an HIV test is essential to treat the person at that point of time, then by all means go ahead and test. However, I suspect that is not the true intention behind such testing. In practice, it would just come down to simple testing without consent which I think is extremely unethical.

In my opinion, if an unconscious person is tested (de-facto no consent is taken) then there *must* be certain caveats to such a test- Confidentiality of the test results need to be ensured etc. But I still lean towards saying no. But like I said in my prior post, there are exceptions.

I am in India btw, and over here it is *illegal* to be tested without the consent of the patient BUT most private and Govt hospitals almost always go ahead and routinely test almost all their patients for HIV without informing them even though it is against the law. It seems as though the Indian Govt tacitly encourages this. I am grossly opposed to such a thing.

The testing without knowledge aspect is the part I disagree with -One of the things that people may not be aware of is that the Joint Commission - which accredits hospitals keeps track of sentinel events at hospitals.

The second most prevalent sentinel event at hospitals overall is inpatient suicide. This occurs many times due to people being dispondent over a diagnosis, such as terminal cancer, etc.

I can't see where informed testing is going to help prevent an escalation in sentinel events - imagine being at the hospital for an injury in a motor vehicle accident - then having it laid on you that you are also HIV+ - when you had no idea that you were even being tested for it....

Or, being in Florida - being told you are HIV+ (when you were tested without your consent) and then being told that you have to go on a waitlist behind 2-3,000 people to get access to life-saving meds.

Knowing one's status without having access to treatment is a recipe for depression....even if the intent is good ---- the road to hell is paved with good intentions.

As it was presented this is not mandatory and without consent testing unless you arrive unconscious. You will be afforded the opportunity to opt out. The percentage of patients that arrive in the ED in an unconscious/unresponsive state is very low. I'd guess the policy is falling under implied consent laws and rules.Due to the stigma attached to the virus perhaps using implied consent should be reconsidered.

I do not receive care at my hospital because of the probable results should my status become public knowledge. I would hate to have my status become public knowledge because I ended up in the ED in an unresponsive state.

I don't understand how anyone could reasonably object to offering cognitive and coherent adults testing as a matter of routine examination.

I may have missed this but if the testing is not paid for by existing ADAP funding how will this cut funding for those currently relying on ADAP? I would argue that by diagnosing infection before CD4 counts hit single digits new patients could begin earlier treatment. This in turn would allow them to continue working and providing their own healthcare insurance. Conversely if we wait until VL hits 1,000,000 copies and CD4 counts reach near 0, we then gain new disabled patients that rely on already underfunded ADAP and other public programs.

I would argue against forced testing but this seems to be routine testing that is voluntary in nature. How can that be bad? I wish my doc had ordered routine testing for me before I hit single digit CD4 and went undetected until I had an OI related lymphoma.

I may have missed this but if the testing is not paid for by existing ADAP funding how will this cut funding for those currently relying on ADAP? I would argue that by diagnosing infection before CD4 counts hit single digits new patients could begin earlier treatment. This in turn would allow them to continue working and providing their own healthcare insurance. Conversely if we wait until VL hits 1,000,000 copies and CD4 counts reach near 0, we then gain new disabled patients that rely on already underfunded ADAP and other public programs.

ADAP is means tested, it's not just for patients on disability so your argument doesn't make much sense. However if you are making the argument just in regards to disability and Medicare then that makes more sense.

What's so special about HIV? Well it's not an acute condition. I can't think of a pressing medical emergency where testing for HIV without the consent of the patient would be a triage priority.

What's so special about HIV? It's a deeply stigmatised condition and people should have the right to consider the ramifications of testing before it occurs. Not just the social ramifications but the legal consequences as well.

People should have the right to refuse an HIV test should the fancy seize them. Not be subjected to the tyranny of Accident and Emergency staff.

MtD

Why invent the wheel? There are not many on this site that can so state so clearly how I feel so frequently! Thank you. I am sure there will come a day when we will disagree and you will twist my balls, but until then, cheers!

Knowing one's status without having access to treatment is a recipe for depression....even if the intent is good ---- the road to hell is paved with good intentions.

This. You experts who are saying that people finding out their status and getting treatment will reduce transmission.. how do you propose paying for this treatment (doctor visits, labs meds)? It's easy to say when you yourself are on treatment and are able to access medical services. But if you're someone who may die because of not being able to access treatment, well, it's a recipe for suicide, or at the least, very severe depression that will also go untreated because of lack of funds and/or insurance.

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I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

The consensus seems to be people should not get tested for HIV unless they are emotionally ready to hear a positive results and they have access to treatment.

Pretty much agree with this -My biggest concern is the access to treatment part -Now, there is a philosophy that was used in the drug addiction field and this was that if enough people presented for treatment than that would show the extent of the problem and the powers that be would then increase the amount of funding to make treatment on demand available - unfortunately, we know that this isn't the case.

This may be the line of thought of those implementing this program ---- test everyone, show the amount of people infected, and then the resources will be made available to treat them ---- however, I think we all can see by the number of people who are on ADAP wait lists and struggling to get insurance coverage, that this will not be the case. Instead, with this type of program, thousands may find out they are positive but then not have access to treatment.

Testing with needed emotional and medical support would be the ideal. Testing without informed consent or even with informed consent but without the resources to treat is a recipe for disaster.

Pretty much agree with this -My biggest concern is the access to treatment part -Now, there is a philosophy that was used in the drug addiction field and this was that if enough people presented for treatment than that would show the extent of the problem and the powers that be would then increase the amount of funding to make treatment on demand available - unfortunately, we know that this isn't the case.

This may be the line of thought of those implementing this program ---- test everyone, show the amount of people infected, and then the resources will be made available to treat them ---- however, I think we all can see by the number of people who are on ADAP wait lists and struggling to get insurance coverage, that this will not be the case. Instead, with this type of program, thousands may find out they are positive but then not have access to treatment.

Testing with needed emotional and medical support would be the ideal. Testing without informed consent or even with informed consent but without the resources to treat is a recipe for disaster.

This sums up how I feel about this issue at this point . It seems to me that this is just a really big expensive experiment at a time when people are already going without treatment as it is . There are so many people who have gone out of the way to go get tested only to learn they have to wait to be treated because of lack of funding , I think these people should be taken care of first . I do realize how funding works and know this doesn't have anything to do with Adap but it still just doesn't sit well with me .

I guess I'm too dumb to understand the logic. How is catching HIV infection as part of consented routine care bad?

If we catch the infection while the immune system is relatively intact, treatment options and costs are significantly better than if we simply wait until the patient presents with an AIDS defining OI.Regardless of how treatment is funded the survivability goes up and the cost of treatment goes down.

One argument seems to be mental health related. Eventually everyone that is infected will be diagnosed. Would it be easier on the patient[s mental health to wait until he presents with AIDS related complications and then say "Oh, by the way, you have AIDS on top of this Cancer and pneumonia."My thinking is it would be easier to get a diagnosis of HIV and a reassurance that "We've caught this early enough that your treatment options are good. Immune system is relatively intact and we don't have to worry about OI's at this point."

If treatment costs are the concern, wouldn't it be cheaper to treat the patient with CD4 of 500 and low VL as opposed to waiting until the patient has several OI's and a completely ruined immune system? Those patients with insurance will be treated under their health insurance. Those on public assistance will still need to navigate the system but by catching it before it's a crisis we give them the opportunity to navigate a very broken system.Ultimately everyone that is infected will be informed they are HIV positive. Everyone that is infected will face the fact that they must enter treatment. Do we have them put their heads in the sand and wait until their infection is at a critical stage or do we try to catch the infection early and treat appropriately?

I guess I'm too dumb to understand the logic. How is catching HIV infection as part of consented routine care bad?

If we catch the infection while the immune system is relatively intact, treatment options and costs are significantly better than if we simply wait until the patient presents with an AIDS defining OI.Regardless of how treatment is funded the survivability goes up and the cost of treatment goes down.

One argument seems to be mental health related. Eventually everyone that is infected will be diagnosed. Would it be easier on the patient[s mental health to wait until he presents with AIDS related complications and then say "Oh, by the way, you have AIDS on top of this Cancer and pneumonia."My thinking is it would be easier to get a diagnosis of HIV and a reassurance that "We've caught this early enough that your treatment options are good. Immune system is relatively intact and we don't have to worry about OI's at this point."

If treatment costs are the concern, wouldn't it be cheaper to treat the patient with CD4 of 500 and low VL as opposed to waiting until the patient has several OI's and a completely ruined immune system? Those patients with insurance will be treated under their health insurance. Those on public assistance will still need to navigate the system but by catching it before it's a crisis we give them the opportunity to navigate a very broken system.Ultimately everyone that is infected will be informed they are HIV positive. Everyone that is infected will face the fact that they must enter treatment. Do we have them put their heads in the sand and wait until their infection is at a critical stage or do we try to catch the infection early and treat appropriately?

All valid points of course, but are still trumped by the matter of individual choice. No one should be forced to be tested, regardless of whether you or I agree with their decision.

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"Hope is my philosophy Just needs days in which to beLove of Life means hope for meBorn on a New Day" - John David

First sentence, not true. My first husband died not knowing he was infected (the autopsy showed PCP).

Second sentence, not true. The face that they "must" enter treatment, or "should?" Some people will never have the resources or help to get treatment.

OK I give up again. But I'll ask before I go:How many people die of AIDS without knowing they are infected? I doubt even 1%

Your also right, some people lack the means for treatment. Does this really mean we should not offer routine CONSENTED testing to everyone, at no charge to them, because of this subset of people?

By getting people tested and into treatment early we improve their health and treatment outcome in a large majority of the cases. Somehow the very people that should understand this, the people of this forum, would prefer that we have everyone bury their heads in the sand and pretend that they can't be infected.

Somehow the consensus seems to be "Wait until they go to the hospital with life threatening OI's and no immune system."I'm truly amazed that the people of this forum that are highly educated with respect to HIV/AIDS, it's transmission, progression, and treatment process would argue against early detection in a manner that is at no charge to the patient, non-mandatory, and fully consented.

OK I give up again. But I'll ask before I go:How many people die of AIDS without knowing they are infected? I doubt even 1%

Your also right, some people lack the means for treatment. Does this really mean we should not offer routine CONSENTED testing to everyone, at no charge to them, because of this subset of people?

By getting people tested and into treatment early we improve their health and treatment outcome in a large majority of the cases. Somehow the very people that should understand this, the people of this forum, would prefer that we have everyone bury their heads in the sand and pretend that they can't be infected.

Somehow the consensus seems to be "Wait until they go to the hospital with life threatening OI's and no immune system."I'm truly amazed that the people of this forum that are highly educated with respect to HIV/AIDS, it's transmission, progression, and treatment process would argue against early detection in a manner that is at no charge to the patient, non-mandatory, and fully consented.

The issue here is not "non-mandatory, and fully consented testing", nor do I see anyone arguing that we should "bury our heads in the sand and pretend we can't be infected".

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"Hope is my philosophy Just needs days in which to beLove of Life means hope for meBorn on a New Day" - John David

The issue here is not "non-mandatory, and fully consented testing", nor do I see anyone arguing that we should "bury our heads in the sand and pretend we can't be infected".

The program at UAB is fully consented with the exception of unconscious patients. It is not mandatory.Several people have argued that we should not offer this program for several reasons including: The possibility of patient suicide, not wanting to learn of infection in this manner, not wanting to learn of infection when family members are around, and because all the newly diagnosed patients would present additional burden on publicly funded programs.

The issue is indeed non-mandatory and fully consented testing. The small subset of patients that present in an unresponsive state being the exception. I agree implied consent with these patients is perhaps something to be reconsidered.

The arguments against this testing are indeed head in the sand arguments. They all amount to "I don't want to know right now" or ""We can't add more patients to an already over burdened public assistance program"My difficulty lies with the fact that the very people who know that early detection leads to improved treatment outcomes are the ones arguing against this program that would help those individuals that would otherwise go undiagnosed until irreparable damage is done to their immune system.Physicians do not routinely offer HIV testing as a matter of course. Instead they wait until an AIDS defining illness occurs or the patient specifically requests testing.

No one is advocating forcibly testing patients. The CDC and UAB are offering routine testing at no charge to all patients presenting at the ED. All patients are offered the option to say no I don't want that test. How can that be bad? The only flaw is implied consent of unresponsive patients. This is a very small subset but should be reconsidered.

The only flaw is implied consent of unresponsive patients. This is a very small subset but should be reconsidered.

That's exactly my point...that's why I said that the controversial issue was not non-mandatory, consensual testing, it was the part where they are proposing to test individuals who may arrive in an incapacitated state and not able to make the decision for themselves on whether to have the test done. I advocate testing as much as you do, but no one should make that decision for someone else, period. It is an entirely personal choice.

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"Hope is my philosophy Just needs days in which to beLove of Life means hope for meBorn on a New Day" - John David

Interesting posts, everyone. I'm still not sure how I feel about this....as jg says, we are just one hospital in one state.....

I do know that detecting HIV early is a big plus to successful treatment. We have so many patients come into our clinic who are deathly ill, with T-cell counts in the double digits....they did not know they had HIV until they became extremely ill from AIDS. I know that this is NOT good! But is testing everyone that comes through the ER the answer? The issues raised about family/friends finding out are pretty much non-existent; UAB is extremely HIPPA-conscious, they would never disclose something like this to someone in front of others. Now, counseling for those who test poz? Not sure if or how they plan to handle this; I think their 'solution' is going to be to refer these patients directly up to our clinic, and let our drastically over-burdoned social workers handle it.

I will certainly keep you posted on how this is working out and affecting us, when it's implemented.

Logged

"Remember my sentimental friend that a heart is not judged by how much you love, but by how much you are loved by others." - The Wizard of Oz

Oh my God, do you not, can you not see the issue with this, let alone if someone was conscious! You clearly are close to a state of un.........

So now you'll attack someone for disagreeing with you and presenting clear argument as to why there is disagreement. I believe I mentioned on several occasions that perhaps the implied consent should be reconsidered.As far as not seeing the issue. No I do not see why offering consented no charge testing is problematic. This is what I am a proponent of. Please present a logical argument as to why offering free, optional, non-mandatory testing is bad.

I think we each bring to this an emotional reaction based on our own recollection and fears. And that is fine.

But public policy needs to be based on facts in effect today and changes in the reasonably forseeable future.

There's a lot of fears expressed that people will get a diagnosis and be unable to access treatment. But many of those fears don't appear to be grounded in the facts of today's environment.

And having people with undiagnosed HIV is a public health hazard both to themselves and to their sex partners. A number of studies have shown that once people know about their infection they are much more likely to take steps to protect their partners, and then, if they get on treatment, to become less infectious.

On to the facts:

-Everyone who gets a diagnosis does not need to go on treatment immediately. As we constantly say to new members, when to start treatment is a decision to be taken seriously in conjunction with a doctor.

-There are many modern HIV drugs, after weeding out the ones with the most toxic effects. Many of these have been around for a long time and there is a deep understanding of the risks, side effects and mitigation strategies. And a large number have been around so long that they are starting to come off patent, at which point their prices will drop dramatically. The US approved a generic for Combivir just in the last month; the manufacturer of Kivexa/Epzicom has stated that its patents have expired although a generic has not yet been approved; Viramune's patents expire in 2012. This will affect both ADAP costs and the ability to construct good and cheap initial regimens.

- Health Care Reform is already partly here and most of it will arrive in only two and a half years. Many young people can get access to health insurance under their parent's health policies today thanks to the new Health Reform Act. And in 2014 the main provisions of the Affordable Care Act go into place, including subsidies for people working at lower paying jobs that don't provide health care.

- ADAP is not the only or even the primary source of coverage. Most people on treatment today do not depend on ADAP. ADAP only covers 120,000 people. That is a fraction of those on treatment. And undiagnosed people walking around with HIV without knowing it are more likely to be employed and to have health care coverage through work. Getting a diagnosis while you can still work and have an income makes it a lot easier to find health insurance and health care than getting a diagnosis when you have 22 tcells and are on disability.

- ADAP waiting lists have created more fear than actual treatment gaps. Even if the undiagnosed are more likely to be employed than those with existing diagnoses, some of them will still need ADAP or a similar program. Waiting lists for ADAP are an embarassment to our nation and create fear and anxiety about access to meds. But, so far, they have not prevented access, because charities have stepped in to fill the gap. Thus arguing that the newly diagnosed will not find treatment because of the ADAP waiting lists is contrafactual.

In sum, fears that people diagnosed under the program will be unable to find treatment are not based on facts, but on unlikely hypotheses. Denying many people and their partners the advantages of knowing their status because of hypothetical fears of lack of treatment access for a few is contrary to the public interest and the public health.

Now granted I might just be waking up from a self induced coma, but this is what you wrote, and honestly, "small" and "responsive" should perhaps be left to "Off Topics" or another site.

I've stayed out of this one because, quite frankly, there isn't a "right answer".... at least not amongst our group. We have a hard time agreeing to disagree on things -- or even, at times, to debate in an agreeable fashion (and I'm not leaving myself out of that group). However, I have to respond to this, because you have, once more, taken a line out of a much larger post to try and pick a fight. Grinch has made it clear that he thinks the ONE group that wouldn't be afforded a chance to consent was an area that he had a problem with -- he stated a few times that this part should be revisited. You choose to pick, pick, pick until it bleeds here. Knock it off and give a cogent response to his ENTIRE post or go to "Off Topics" yourself. It is simply impossible to debate with someone who isn't willing to be fair (sort of like Ms. Palin here.....).

Beginning in mid-July, UAB (University of Alabama at Birmingham) Hospital will start screening all ER patients (unless they sign a form to opt-out) for HIV. If they come in unconscious or unable to communicate, they will be tested.

Overall, I think it's a good idea to do routine testing, but I know the funding is not there to treat those who test positive. Our patient load has already surpassed 2,000.

Because I responded a couple of times in this thread - I wanted to make sure that my issues and/or support were clarified.1) I am all for routine, voluntary, consensual testing that involves active consent.2) My issue with the UAB Hospital plan as it is stated is that: a) it is not always going to be voluntary (i.e. if someone is brought in unconscious); and b) it is passive consent (i.e. a person will be tested UNLESS they sign a form to opt-out - why not reverse that and have them sign a form to opt-in and consent to the test, rather than making them sign a form NOT to consent to the test3) If testing is going to be done - then it is imperative to have a plan of action to link the person to treatment - keep in mind that treatment doesn't always mean going straight onto meds - it is just that - treatment (i.e. seeing a doctor, getting all of the baseline labs done, regular monitoring, whether the person is on meds or not)4) It is also imperative to have other support structures (i.e. mental health counseling) accessible - as we can see just from these forums and the AM I forum, getting tested can bring up a lot of emotions and worries - this doesn't mean a person shouldn't get tested, but it does mean that a testing program has to have adequate resources to provide appropriate pre and post test counseling. This may be difficult to do in the fast moving and very transitional environment of an emergency room.

I also think the below map showing the percentage of people by state living with HIV/AIDS and not in care is significant - particularly when it shows Alabama to be one of the states with a higher percentage of persons who know their status but are not in care:

3) If testing is going to be done - then it is imperative to have a plan of action to link the person to treatment - keep in mind that treatment doesn't always mean going straight onto meds - it is just that - treatment (i.e. seeing a doctor, getting all of the baseline labs done, regular monitoring, whether the person is on meds or not)4) It is also imperative to have other support structures (i.e. mental health counseling) accessible - as we can see just from these forums and the AM I forum, getting tested can bring up a lot of emotions and worries - this doesn't mean a person shouldn't get tested, but it does mean that a testing program has to have adequate resources to provide appropriate pre and post test counseling. This may be difficult to do in the fast moving and very transitional environment of an emergency room.

The one thing I don't get about this particular argument (I'm not picking on your Phil -- many of voiced it here and in past threads on this topic) is:

If these requirements can't get met and testing is not done (with consent or not), then we really don't alleviate the NEED for treatment and support -- we are simply avoiding the KNOWLEDGE of the NEED. I've always been confused as to why we say, in one breath, that we need to fight stigma of HIV, and in the other say that we need to provide extra special hurdles to it. We tell people that they should let the health care providers know about their status so that they can be properly treated, yet we put up barriers to those that don't know from finding out -- so they can't get proper treatment. It's a virus and if we keep treating it differently from all other viruses, then the general public will also continue to treat it differently. There are damned few medical tests that require written consent -- I can't even think of another right now, although I'm sure there must be.

Anyway -- my point is that at some point in time, we all have to stop treating this virus in accordance with it's stigma -- else we will never lose that stigma.

test the bastards. i unknowningly contracted it and just because i consented to finding out did not make the diagnosis any better. if i were in a car accident, rendered unconscious, and someone ran a battery of tests on me and told me the news in an appropriate setting i'd get over it. FORTUNATELY, im not everybody (this sentiment has been echoed by my parents and the last few guys ive fucked or been fucked over by).

if we did not have multiple levels of interactions with other people in society id probably lean more towards consensual testing and opting in. oh, wait, thats right. the bastard i think i got it from (sarcastic lol) knew and we still fucked without a condom, im such a owner of that one. anyhow, just cause some people know their status wont necessarily lead to safer interactions with the public and themselves. given this im still not a fence sitter and would prefer greater testing. fuck, it make it part of the check up reqs when they fully roll out heath care reform.

i believe routine screening should include hiv. of course consensual testing is preferred but if it aint then at least when the person finds out they can do something with that knowledge. and knowledge is power....gi fucking joe.